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Outcomes in Patients With Non-small-cell Lung Cancer With Brain Metastases Treated With Pembrolizumab-based Therapy
Lova Sun1, Christiana W Davis1, Wei-Ting Hwang2
1Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
Background:
Patients with metastatic non-small-cell lung cancer (mNSCLC) and untreated brain metastases (BM) have been excluded from most trials of immune checkpoint inhibitors (ICIs). Real-world evidence on efficacy and survival outcomes of ICIs in patients with BM is limited.
Patients And Methods:
We conducted a single-center retrospective study of patients with mNSCLC treated with pembrolizumab with or without chemotherapy and compared progression-free survival (PFS) and overall survival (OS) between patients with and without BM using Kaplan-Meier and Cox methodology. We also characterized systemic and intracranial objective response rate (ORR) and treatment details, including timing of cranial irradiation.
Results:
Between Augutst 2013 and December 2018, 570 patients with mNSCLC treated with pembrolizumab-based therapy were analyzed. Of 126 (22.1%) patients with BM, 96 (76.2%) had treated BM (local therapy prior to pembrolizumab), and 30 (23.8%) had untreated BM. Of patients with untreated BM, 17 (56.7%) underwent radiation within 30 days after pembrolizumab initiation. In the remaining 13 (43.3%) treated with pembrolizumab-based therapy alone, intracranial ORR was 36.4%. Patients with and without BM did not have significantly different systemic ORR (27.8% vs. 29.7%; P = .671), PFS (mPFS 9.2 vs. 7.7 months; P = .609), or OS (mOS 18.0 vs. 18.7 months; P = .966). Factors associated with improved survival on Cox analysis included female gender, performance status, adenocarcinoma histology, and first-line therapy.
Conclusions:
Patients with BM did not have inferior survival to patients without BM after treatment with pembrolizumab-based therapy. In the current era, BM may not automatically confer inferior survival, and should not exclude patients from receiving pembrolizumab-based therapy.
Insights
Patients with metastatic non-small-cell lung cancer and brain metastases (BM) showed similar survival outcomes when treated with pembrolizumab-based therapy compared to those without BM. Brain metastases should not exclude patients from this effective treatment.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Trials
Background:
- Metastatic non-small-cell lung cancer (mNSCLC) patients with untreated brain metastases (BM) are often excluded from clinical trials of immune checkpoint inhibitors (ICIs).
- Limited real-world data exists on the efficacy and survival of ICIs in mNSCLC patients with BM.
Purpose of the Study:
- To evaluate the efficacy and survival outcomes of pembrolizumab-based therapy in mNSCLC patients with and without BM.
- To compare progression-free survival (PFS) and overall survival (OS) between these patient groups.
Main Methods:
- Retrospective single-center study of 570 mNSCLC patients treated with pembrolizumab +/- chemotherapy.
- Kaplan-Meier and Cox regression analyses were used to compare PFS and OS.
- Systemic and intracranial objective response rates (ORR) were characterized.
Main Results:
- Of 570 patients, 126 (22.1%) had BM; 30 (23.8%) had untreated BM.
- Patients with and without BM showed similar systemic ORR (27.8% vs. 29.7%), PFS (9.2 vs. 7.7 months), and OS (18.0 vs. 18.7 months).
- Intracranial ORR was 36.4% in untreated BM patients receiving pembrolizumab alone.
Conclusions:
- Brain metastases did not confer inferior survival outcomes in mNSCLC patients treated with pembrolizumab-based therapy.
- BM should not automatically exclude patients from receiving pembrolizumab-based therapy.
- Current evidence suggests BM may not predict poorer survival in the context of ICI treatment.
